Health Insurance – Cieranthttp://www.cierant.com Mon, 07 May 2018 18:42:42 +0000en-UShourly1CMS Decreases Regulatory Burden to Increase Innovationhttp://www.cierant.com/cms-decreases-burdens-to-increase-innovation/ http://www.cierant.com/cms-decreases-burdens-to-increase-innovation/#respondMon, 30 Apr 2018 18:04:07 +0000http://www.cierant.com/?p=6860“Regulations do have their role. They’re very important to assuring patient safety and quality and for program integrity, but there’s a fine line between being helpful and being a hindrance,”– Seema Verma, Administrator for the Centers for Medicare and Medicaid Services

That quote captures CMS’s current sentiment. The agency is striving to reduce overly burdensome regulations on providers and payers to enable them to spend more time taking care of patients and less time on paperwork, reporting and compliance measurement. This sentiment was backed by the new policies of the Medicare Advantage (MA) and Part D Final Rule and Final Call Letter, released on April 2nd of 2018.

The policies of the Final Rule are reflective of collective input CMS solicited from beneficiaries, plan sponsors and advocacy groups on how MA and Part D plans could be transformed to give beneficiaries more coverage options and payers the tools and efficiencies needed to deliver IT innovation. The policy changes of the Final Rule, coupled by those outlined in the Final Call Letter, represent steps being taken to reduce regulatory obstacles to improved healthcare delivery and expansion of options available to beneficiaries.

While the Final Rules will not go in effect until January 1, 2019, below are some of the highlight changes so you can start thinking ahead:

Return of Medicare Advantage Open Enrollment

The Medicare Advantage Open Enrollment Period will return in 2019 in replacement of the existing MA disenrollment period that takes place from January 1st through February 14th. The New MA open enrollment period (OEP) will occur January 1st through March 31st and willl allow newly MA-eligible individuals, as well as current MA enrollees, to make a one-time election to switch to another MA plan, leave their MA plan or return to Original Medicare Part A and Part B. MA beneficiaries can also add or drop Part D coverage, however, this enrollment period does not allow for Part D changes for individuals enrolled in Original Medicare, including those with enrollment in stand-alone PDPs.

CMS expects approximately 558,000 Medicare beneficiaries will use the OEP to make an enrollment change. Reinstitution of OEP will allow those who missed out on the fall Annual Enrollment Period to have another opportunity to get into Medicare Advantage or to change from one plan to another. This is part of CMS’s initiative to give beneficiaries more time and information to make smart decisions about their healthcare and pharmacy benefits.

Expansion of Patients over Paperwork Initiative

Earlier in the year CMS launched a “Patients Over Paperwork Initiative,” which aims to reduce unnecessary burden regulation in order to improve quality and speed of care.

The final rule furthers this initiative by:

Authorizing CMS to permit plans to use notice of electronic posting (and provision of copies upon request) to satisfy disclosure requirements for certain bulky documents to Medicare beneficiaries, thereby empowering patients with the information to make their own healthcare decisions

Eliminates requirements that plans submit, in addition to their bids, similar and overlapping accounting information

Makes it easier for plans to communicate with beneficiaries by streamlining government review and approval of marketing materials used by plans

Eliminates enrollment requirements for healthcare providers and prescribers that bring value to Medicare Advantage and Part D beneficiaries

Separation & Allowance of EOC E-Delivery

CMS is separating the delivery date of the Annual Notice of Change (ANOC) from the Evidence of Coverage (EOC) so that Medicare beneficiaries receive the ANOC first, as a stand-alone document, in order to give beneficiaries the information they need to make a fully informed plan selection decision. As noted by CMS, the “ANOC must be delivered 15 days prior to the Annual Election Period (AEP) and will be received by enrollees ahead of the EOC, thus allowing enrollees to focus on materials that drive decision-making during the AEP.” Plans should aim to have EOC’s delivered before or at the start of AEP—October 15th.

In addition, MA and Part D sponsors can now provide certain materials, such as the EOC, electronically. When doing so, plans are required to provide beneficiaries with easy access to hardcopy materials upon request. Although they did not specifically reference mandatory disclosure materials, beyond the EOC, the agency stated that they are permitting plans to use notice of electronic posting—and provision of copies upon request—to satisfy disclosure requirements for certain bulky documents to Medicare beneficiaries. Noting that approximately two-thirds of Americans 65 and older now use the internet, CMS hopes to bring Medicare communications into the online era and estimates the change will result in savings of almost $55 million per year.

Narrowing Marketing Material Oversight

Acknowledging that its previous definition of marketing material was too broad, CMS changed the definition of what is considered a marketing material to only items that “are most likely to lead to a beneficiary to make an enrollment decision.” They will now only review and approve marketing material aimed at influencing beneficiary decisions in order to reduce the amount of materials health plan marketers need to submit for approval. To account for the materials that will now fall outside of the new marketing definition, CMS is adopting more appropriate requirements and oversight for a new category of materials and activities called “communications.” By streamlining government review and approval of marketing materials used by plans, CMS hopes to make it easier for plans to communicate with beneficiaries.

In conjunction with these efforts to reduce required data submissions and reviews, CMS also narrowed the amount of data that MAOs must provide in their annual Medical Loss Ratio (MLR) reports. Rather than providing line item information about the various expense categories, MAOs will now be required to provide four reportable pieces of MLR information: the organization’s name, contract number, adjusted MLR and remittance amount.

Expanding and Improving Benefits Design

The Final Rule and the Final Call Letter implemented significant changes to the uniform benefit, supplemental benefit, and meaningful difference rules, giving MAOs substantially more flexibility in designing and targeting benefits for members with specialized medical needs.

The meaningful difference requirement set regulations in place for how MA plans offered by the same organization in the same county must differ. Beginning CY 2019, CMS is eliminating this requirement as they believe that it can at times prompt plans to reduce the value of certain benefit offerings in order to comply. Without the meaningful difference limitation, MAOs will have the ability to offer multiple plans with slightly varied benefit designs in order to target new disease- and condition-specific benefit plans towards particular populations.

CMS also reinterpreted uniformity requirements to expand the ways MA plans can offer supplemental healthcare benefits to beneficiaries. Previously, MAOs were required to offer plans with uniform benefits, premiums and cost-sharing throughout the plan’s service area, but in a “reinterpretation” of this authority, MAOs can offer tailored supplemental benefits, so long as there is a connection between the benefit and the health condition the benefit is designed to address, confirmed through diagnosis. “It must diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization,” CMS stated. Though CMS did not specify what kinds of “extras” could now be included, speculation has emerged that services as diverse as home meal delivery, ride-sharing transportation to medical appointments, assistance devices, and non-skilled, in-home care could become regular benefits, even though similar options are not allowed in traditional Medicare.

By 2020, MA plans will be able to offer three categories of supplemental benefits: standard (offered to all enrollees), targeted (based on health status or disease state) and chronic (offered to the chronically ill). MA plans will need to identify the category of each benefit being offered in their bids and Evidence of Coverage documents.

Standardizing Star Ratings Methodologies

CMS finalized regulations for the Quality Star Ratings program, which assigns rating to sponsors that are used in plan marketing materials and which Quality Bonus Payments are based upon. In addition to codifying the Star Ratings system so beneficiaries can make more informed coverage choices, CMS put measures in place to ensure that the quality and consistency of data submitted is reflected in these ratings. These measures include using an enrollment-weighed average to calculate the Star Ratings for recently consolidated contracts and standardizing its star reduction calculation policy for contracts with data integrity issues.

Conclusion

Verma noted that these policies “should serve as tangible examples of our commitment to putting patients first and empowering them with the information they need to make healthcare decisions that are right for them, lowering their drug costs and reducing provider burden to allow them to spend more time on their primary mission—improving their patients’ health and lower drug prices for seniors on Medicare.”

CMS also claims that the final changes will result in an estimated $295 million in savings a year for the Medicare program over 5 years (2019 through 2023) – resulting in lower premiums or additional benefits.

For payers, these Final Rules not only mean lower drug costs and premiums for their members, but greater flexibility on their end to deliver personalized communications, engagement and benefits to members at reduced cost and higher efficiency. The expansion of supplemental benefits could also spur the development of a new healthcare model, as it opens the doors to integration with new partners and technologies to deliver services that address the social determinants of health. While CMS indicated that more detailed guidance would be released later in the year on supplemental benefits, the ability to potentially offer varied benefits to different populations signifies a major shift towards a personalized, patient-first healthcare delivery model.

]]>http://www.cierant.com/cms-decreases-burdens-to-increase-innovation/feed/0Winning AEP 2018 Direct Mail Tacticshttp://www.cierant.com/winning-aep-2018-direct-mail-tactics/ http://www.cierant.com/winning-aep-2018-direct-mail-tactics/#respondMon, 30 Apr 2018 17:55:59 +0000http://www.cierant.com/?p=6854Each year, Medicare healthcare providers struggle to create AEP marketing pieces that drive new member acquisition. Like any industry, the marketing landscape and audience are constantly changing. Seniors today are living a drastically different lifestyle than seniors 15 years ago. Internet and smartphone adoption continues to increases among this group, making them more socially connected and digitally engaged than ever before. These behavioral and social changes require new marketing approaches that reflect the evolving attributes of today’s Age-In.

While some plans failed to reach their target acquisition numbers last AEP, three companies updated their Age-In direct mail marketing approaches and saw it pay off in enrollment numbers.

According to CMS, the top three performing companies during the 2018 Annual Enrollment Period (AEP) were UnitedHealthcare, acquiring almost 400,000 new members, Aetna, obtaining 350,000, and Humana, gaining over 200,000. In an analysis of their campaigns, several unique tactics were found to be leveraged by all three. These tactics that helped to drive response rate success include:

1. Dismantling Stereotypes Two of the top three companies with the highest enrollment gains focused their AEP 2018 campaign strategies on the fact that people over 65 look and act quite differently than this age group did ten or twenty years ago. In addition to this age group being more social and active, this audience often even thinks they look younger than they do, and thus can be turned off by marketing pieces featuring models looking too old. Recognizing this reality, Aetna and United carefully selected and leveraged images of vibrant, active seniors to improve the visual relevancy, and in turn, appeal, of their direct mailers. Aetna further dissolved historical Age-In stereotypes with a postcard featuring an older woman at a coffee shop and the bold headline, “I use three different dating apps” followed by the punchline, “The face of medicare is changing.”

2. Focusing on “Extras” According to Deft Research, “along with drug coverage, dental coverage stimulates the most shopping among seniors.” This is because many seniors currently have unsatisfactory dental coverage. According to the National Health and Nutrition Examination Survey (NHANES III), 57% of Americans ages 65 to 74 have full or partial dentures, however most Medicare dental plans do not cover this necessity. Vision and hearing care also remain inadequate for Medicare beneficiaries, so highlighting these programs in your direct mail marketing can really grab attention. Another Extra that proves of interest to all age groups are wellness program perks, such as discounts on local services and free gym memberships.

3. Offering Access to Personalized Agent/Broker Support Today’s seniors are increasingly engaging in online shopping activities and while they find the abundance of online information and decision support tools helpful, many still do not feel confident weighing the information on their own. Online shopping resources are proving effective in driving plan awareness and supporting the shopping process, but are still not trusted by seniors as the sole source for plan selection decision making. According to Deft Research’s “2018 Medicare Shopping and Switch Study,” many seniors still need the assurance of consulting with a professional, and agents facilitate almost 50% of the occasions when a senior switches from one plan to another.

Prepping for AEP each year is a challenge for insurance marketers, especially at smaller companies that may not have the resources of Aetna, but incorporating these three proven-effective tactics can help capture the opportunity of the growing Age-In market.

]]>http://www.cierant.com/winning-aep-2018-direct-mail-tactics/feed/0CMS Intensifies Provider Directory Penalties: 2019 Draft Call Letterhttp://www.cierant.com/cms-intensifies-provider-directory-penalties-2019-draft-call-letter/ Tue, 06 Mar 2018 18:40:18 +0000http://www.cierant.com/?p=6581The Centers for Medicare and Medicaid Services (CMS) requires plans to monitor and conduct regular updates of their provider network data, including updating providers’ ability to accept new patients, as well as their office address, phone number and any other changes that affect availability. Medicare Advantage (MA) plans must contact providers every three months and update their online directories in real-time. These mandates were put into place after reviews of provider directories found that in many cases, as many as half of the providers listed were no longer participating in the plan at the specific location, and in some instances, were no longer participating in the plan at all. But how are payers doing in meeting this new guidance?

The Centers for Medicare and Medicaid Services (CMS) completed two rounds of MA online provider directory audits. The second round, conducted by phone as a “secret shopper” style audit, looked at the accuracy of 12,780 provider locations across 55 Medicare Advantage health plans and found that 52.6% of the locations listed on provider directories had at least one of the following inaccuracies:

The provider was not practicing at the location listed or not accepting patients at the location.

The phone number was incorrect or disconnected.

The provider was not accepting new patients when the directory indicated they were.

The provider was not accepting the health plan at the location.

The first audit review, conducted back in 2016, found that 45% of locations listed were inaccurate. While this year’s audit was conducted with a slightly different methodology, it still reveals little to no improvement. CMS noted that its findings were not skewed by a few organizations, but instead were widespread in the sample reviewed, which was about one-third of all MAOs. “Very few organizations performed well in our review,” the agency said. This news comes in the wake of an 8% spike in Medicare Advantage membership, which is concerning because with more members, comes more potential provider access complaints and more risk to the member satisfaction scores that impact Medicare Star Ratings.

The 2017 CMS audit findings indicate the following as common drivers of provider data inefficiencies:

Group practices continue to provide data at the group level rather than at the provider level.

Provider directories convey an inflated number of locations where the provider practices.

A general lack of internal audit and testing of directory accuracy.

Too many instances where providers were deceased or retired for several years.

A group practice often lists a provider at a location because the group has an office there, but that specific provider may rarely or never see patients at that location, with this being one of the greatest drivers of data inaccuracy. Another major issue is that MA plans are putting full faith in credentialing and vendor services, but need to conduct more personalized, direct outreach to providers to get data validated on a routine basis that is coming directly straight from the source.

CMS encourages MAOs to “actively use the data available to them, such as claims, to identify any provider inactivity that could prompt further investigation.” The agency emphasized that MAOs themselves “are in the best position to ensure the accuracy of their plan provider directories.” It also said it was encouraged by pilot programs aimed at developing a centralized repository for provider data that would be accessible to multiple stakeholders.

In response to identified directory violations, CMS issued the following actions:

• 12 Medicare Advantage health plans with error rates between 97.2%- 60.9% were issued a warning letter with a request for a business plan to define fix for the issue • 19 Medicare Advantage health plans with error rates between 58.3%-40.1% were issued a warning letter • 23 Medicare Advantage health plans with error rates between 38.8%-10.4% were issued a notice of non-compliance • 1 Medicare Advantage health plan with error rate of 9.6% passed the audit with no compliance action

However, the soft policy days of issuing warning letters might soon be over, as the troubling findings of the audits translated into new proposed violation consequences, detailed in the 2019 Draft Call Letter.

CMS released the Medicare Advantage 2019 Call Letter in two draft notices. The first came in late December and the second in early February. The 2019 MA Draft Call Letter specified that civil money penalties and other enforcement actions would now be imposed for provider directory violations. Plans that have received a non-compliance notice for violations and have failed to make corrections will be subject to these penalties. CMS states that penalties for provider directory errors will initially be calculated on a per determination basis, leaving us to wonder whether it will be calculated on a per enrollee basis in the future. CMS also states that they have the discretion to take enforcement actions when an egregious instance of non-compliance is discovered.

But perhaps even more alarming to health plans was the proposed policy on public reporting of issued civil money penalties. The draft letter states that CMS plans to begin publicly reporting CMPs on its Medicare Plan Finder in order for beneficiaries to more easily identify which organizations have received a CMP. This would include placing a CMP icon on the sponsor’s listing in the MPF. Should CMS move forward with issuing CMPs for these violations and implementing CMP icons, sponsors could find themselves adversely impacted not only by financial penalty, but by the increased visibility and resulting negative public perception.

The quality of your provider data not only impacts your ability to remain compliant and avoid hefty fines, it also impacts your service to your members. Errors in MAOs provider directories not only anger members who rely on that data to make appointments and get directions, but prevents them from accessing services that are critical to their health and well-being. Inaccuracies can also cast doubt on the adequacy and validity of the MAO’s network as a whole, deteriorating trust in the plan and lessening member engagement. With MA plan switching at an all-time low, it is imperative MAOs retain their existing base while maintaining a positive image that attracts new enrollees.

Without collaboration and the development of creative solutions that can improve directories with minimal administrative burden, directories will continue to be a problem. Current phone and fax-based data validation methods no longer suffice. Health plans need digital tools that can centralize data access and simplify the collection and review process, but these tools will only succeed if supported by ongoing provider outreach campaigns and an internal team tasked with overseeing the process. In the near-term, CMS advises MAOs to perform their own audits of their directory data and develop better internal processes for members to report errors.

]]>Three Icons Look to Transform Healthcarehttp://www.cierant.com/three-icons-look-to-transform-healthcare/ Tue, 06 Mar 2018 17:58:14 +0000http://www.cierant.com/?p=6601We’ve seen Amazon transform retail through their ability to remove the layers of the standard business model and redefine how consumers shop for, pay for, order and receive products. Now, with slow-to-evolve brick and mortar retailers left in the dust and others still scrambling to compete, Amazon is setting its eyes on an all new market: healthcare.

On January 30th, 2018, Amazon’s founder, Jeff Bezos, announced that the company was joining forces with Berkshire Hathaway and JPMorgan Chase to improve healthcare and lower its cost for their hundreds of U.S. employees, which equates to over 900,000 worldwide. Their companies will form an independent healthcare company, leaving insurers, drugmakers, and pharmacy benefit managers to face the ripple effects of market disruption. Stocks of several major health care companies, including insurer UnitedHealth Group, pharmacy benefit manager Express Scripts, drugmaker Amgen, and drugstore chain CVS Health, the recent buyer of insurer Aetna — suffered losses immediately following the announcement.

Alongside Bezos are two other business titans leading the venture — world-famous investor and CEO of Berkshire Hathaway, Warren Buffet — and Jamie Dimon, Chairman, CEO, and President of JPMorgan Chase. With the coalition including two of the world’s richest people and one of its most powerful financial executives, skepticism is minimal. Most experts and analysts say they can easily see a place for an “Amazon-like company” in the health care market.

“Tackling the enormous challenges of healthcare and harnessing its full benefits are among the greatest issues facing society today,” Jeff Bezos, Amazon’s founder said in a statement. “By bringing together three of the world’s leading organizations into this new and innovative construct, the group hopes to draw on its combined capabilities and resources to take a fresh approach to these critical matters.”

The critical issues they’re looking to address? High costs driven by corporate bureaucracy. Benefits navigation complexity. Prescription ordering and delivery inefficiency. Lack of digital workforce transformation. Limited transparency into quality and costs. And that’s just the tip of the iceberg! The immediate and most pressing goal for Amazon, Berkshire and JPMorgan, however, is controlling their own significant healthcare expenses. Those growing costs “act as a hungry tapeworm on the American economy,” Buffett said in a statement.

The unnamed company will initially consist of Berkshire Hathaway investment officer Todd Combs, JPMorgan Chase managing director Marvelle Sullivan Berchtold, and Amazon senior vice president Beth Galetti. Other operational details, including headquarters location and long-term management team will be announced in the future, the companies said.

But what specific aspects of healthcare might Amazon be positioned to take on? Below are some of the possibilities experts foresee.

Improving Prescription Fulfillment, Delivery & Cost

The complex nature of pharmaceutical manufacturing and delivery is widely seen as a contributor to high costs. One layer of the system that remains confounding is a category of companies called pharmacy benefit managers, or PBMs, such as Express Scripts and CVS Health’s Caremark. Those two firms alone control about 50% of the category. As middlemen, PBMs handle drug distribution. Some industry leaders blame PBMs for high drug costs, but with Amazon signaling possible intention to launch an online pharmacy, there is potential to cut them out or at least reduce their cost influence.

Amazon has long considered becoming a vehicle for affordable pharmaceutical prescription sales. Speculation intensified after the St. Louis Post-Dispatch reported that Amazon had received approval for wholesale pharmacy licenses in at least 12 states. The licenses are no where near what’s needed to begin shipping drugs to consumers though. The existing licenses give Amazon the ability to sell medical professional-use-only products, such as sutures, ultrasound gel and syringes for use in medical and dental offices or hospitals. Delivering prescription drugs might seem like simply a transportation issue, but it’s not.

“Neither Amazon nor any other online seller can just put drugs next to toys, books and household staples in its warehouses and ship them all in the same box to homes due to complex, state-based regulations around prescriptions,” said Marcus Ehrhardt, partner of the consulting firm PwC’s pharma and life sciences division.

Should Amazon be able to get the required licensing to launch an online pharmacy, they would be able to introduce price-lowering competition, reducing reliance on mail order services and leveraging their network of partnerships with world-class carriers to get prescriptions to patient’s homes with unprecedented speed.

“We recognize that there will be a variety of different models that can each play an important role in successfully controlling health care costs,” CVS Health said in a statement. “We welcome the opportunity to work with all market participants towards the goal of better health outcomes at lower costs.”

Leveraging Data to Motivate Healthy Living

Amazon is not just a master of fulfillment and shipping, but a master in cloud computing and big data. The company excels at analyzing enormous amounts of data to deliver personalized product recommendations in real-time that motivate customers to take specific actions, an incredibly important capability in driving healthcare wellness programs. These powerful data analysis and personalization capabilities could be used to better track, monitor and drive specific consumer healthcare behaviors, particularly among high-risk and chronically ill populations.

Chronic diseases represent about 90% of U.S. health care spending, according to RAND Corp., but many of those conditions could be mitigated with healthier living. Changing behavior sounds practically impossible — except Amazon has done it in retail. One example of this could be with medication adherence. Some 40% of Americans never get their prescriptions filled, and 40% of those who do never get them refilled. Amazon could possibly detect when a consumer is delinquent in ordering a prescription and trigger a reminder communication. They could also assess purchase data of over-the-counter drugs in relation to doctor visits, and send personalized recommendations for more effective treatments and specialists, with consumer reviews and pricing made readily accessible. They could also make better use of claims data to create dynamic customer profiles that can power personalized care management. The data possibilities, and in turn, connected care solutions, are truly endless with analytics powerhouse Amazon and their world-class Web Services involved.

Enabling Alexa as a Personal Health Assistant

Many see Amazon’s digital assistant Alexa playing a potential role in healthcare. While health plans currently offer 24/7 nurse hotlines and Teladoc services, Alexa opens the door to all new virtual health support possibilities. Imagine telling the Amazon Echo your ailments and receiving personalized treatment and doctor recommendations that leverage the medical and prescriptions claims data housed in your “Amazon Prime Healthcare Account”…with doctors available for live chat to fulfill drugs orders and answer questions. The missing link for Amazon, of course, is the doctors and prescribers, which represent huge regulatory and logistical hurdles.

Driving Down Costs Through Disruption

Just as Amazon provided low product prices for consumers by bludgeoning traditional retailers, the coalition could eliminate layers of the health care system to strip out costs. “Amazon’s track record of disrupting well-established industries can’t be discounted,” Jefferies stock analyst David Windley said in a note to investors.

Perhaps the biggest key to the coalition leaders’ strategy is their disavowal of profit motives. The new company they plan to establish will not seek to profit off of health care, unlike the industry’s leading for-profit insurers, drug makers and many health care providers. “Bezos and Buffett very much understand playing the long game instead of the drive for quarterly earnings — and that’s essential in trying to solve the problems in health care,” says Verrill Dana, legal professional James Roosevelt, Jr., who up until now served as CEO of Tufts Health Plan and chair of insurance trade association for America’s Health Insurance Plans.

U.S. employers provide health care insurance to about 150 million people, and although Amazon, Berkshire and JPMorgan represent only a sliver of that pie, it’s “a significant enough use-case to see how employers can help to drive down the costs,” said Vaughn Kauffman, U.S. health services and new entrants advisory leader for PricewaterhouseCoopers. The partnership of the three companies emphasizes the dissatisfaction employers have with the costs of health care, he said, and if one employer of nearly a million people makes a move like this, it’s naturally going to cause a domino effect across the industry.

New Thinking – New Results.

Republicans and Democrats have been struggling for decades to fix our broken healthcare system, but perhaps these three business titans can finally overcome party divisions and unite the country around progressive, technology-based solutions. While we cannot predict exactly how they will apply data and technology to create an enhanced healthcare delivery model, one thing is clear – they will not be just another startup insurance company, but the foundation of an all new insurance model that will stimulate desperately needed industry growth.

]]>UnitedHealthcare’s Debuts Digital Playbookhttp://www.cierant.com/unitedhealthcares-debuts-digital-playbook/ Wed, 31 Jan 2018 20:47:52 +0000http://www.cierant.com/?p=6496At the International Consumer Electronics Show (CES) 2018 in Las Vegas, UnitedHealthcare demonstrated some of their latest digital health innovations, each designed to help simplify the consumer health care experience of Employer-Sponsored (Group) insurance plans. Three of the core innovations, soon to re-define the way millions of their enrollees select, enroll and use their healthcare, include:

Personalized On-Boarding Platform:

Employees are being presented with more and more different health plan options from their company and even though they may all be from the same carrier, they are each extremely different in benefits design, making it difficult to determine which is most suitable to one’s unique individual or family needs and budget constraints. United’s digital on-boarding platform helps make the decision more straight forward through a step-by-step process that helps guide employees to the plan that’s most right for them. This process is primarily driven by a survey that enables employees to enter aspects of their personal and financial health, then view and select the relevant clinical, wellness or financial programs available offered through each plan, including behavioral health, weight loss, pregnancy support, spending account, and other programs that are key drivers of plan selection.

Apple Pay® Options for HSA:

UnitedHealthcare Individual and Employer-Sponsored plan participants with Optum Bank health savings accounts and an Apple device are now able to pay for HSA-eligible medical and prescription expenses with Apple Pay, one of the easiest and most secure ways to pay today for Apple device owners. All the member needs to do to activate Apple Pay is to add the Optum Bank debit card information to their Wallet app. To pay at pharmacies that support Apple Pay, all the consumer needs to do is press the Apple Pay symbol on the card reader, press their finger to the Touch ID button on their phone, and hold the phone near the card reader screen. That’s it – no swiping – no entry of card data – and less time at the register as a result. In having Apple Pay right in your phone- everywhere you go, members are always prepared to cover unexpected medical expenses. This is of huge convenience in those long post-work pharmacy lines many of us are familiar with. Apple Pay is also the easiest way to pay on the web when purchasing prescriptions online for home delivery or paying for medical expenses. So long as you’re using an iPhone, iPad or Mac device, you can pay with the Touch ID – never having to create an account or fill out lengthy forms of bank information. This is not only a more convenient option, but also more secure as your card number is never stored on your device or on Apple servers, and you’re never exchanging card information with merchants.

Customized Claim Videos:

One of the most challenging aspects of managing one’s healthcare benefits can be interpreting Evidence of Benefits – a document you are sent following the occurrence of a medical expenses that explains how much insurance covered and how much you owe, but typically in a highly convoluted way with a variety of complex codes you must refer to. While other payers have tried to ease EOB understanding by creating interactive PDFs with help tabs and virtual concierges, UnitedHealthcare took it ten steps further by developing personalized videos to explain each and every member’s EOB. The brief videos provide a step-by-step breakdown of exactly how each claim was processed and how much is owed. Plan participants will be able to access customized videos in early 2018 via desktop computers and mobile devices.

Other digital innovations that were demonstrated at CES 2018 include UnitedHealthcare Motion®, the UnitedHealthcare Healthy Pregnancy mobile app, Virtual Visits, and the health and well-being solution – Rally®. Earlier in the week, UnitedHealthcare also announced a collaboration with DexCom, Inc. to launch an individualized glucose management program driven by wearable technology and personalized support to help people with Type 2 diabetes manage their condition in real-time. That initiative is part of a broader effort called Navigate4Me, in which health navigators help MA members manage chronic diseases by leveraging various data sources. Each of these strategic partnerships and supporting digital technology innovations are orientated around making it easier for people to select, use and understand their health benefits during enrollment and following medical care through highly personalized and connected, cross-device content.

“Consumers are asking for and expecting customized, connected digital health resources that help make access to care easier and more convenient,” said Richard Migliori, M.D., chief medical officer of UnitedHealth Group. “UnitedHealthcare invests more than $3 billion annually in data, technology and innovation to help design a health system that is more personalized, intuitive and efficient.”

]]>Restructuring Your AEP Marketing for Successhttp://www.cierant.com/restructuring-your-aep-marketing-for-success/ Wed, 31 Jan 2018 20:46:44 +0000http://www.cierant.com/?p=6456Connecture, in partnership with Deft Research, conducted a webinar last week that took a deep dive into Medicare AEP in order to understand how shopping and switching behaviors are changing among Age-Ins and how payers can most effectively adapt in order to improve new member acquisition. Leveraging national data from Deft Research’s 2017 and soon to be released, 2018 Age-In report, seven direct takeaways emerged that health plans can apply to improve their AEP marketing efforts this year.

Shopping Increasing – Switching Declining:

In 2017, 50% of seniors eligible for Medicare did not shop around, but 40% did – a large jump in comparison to prior years. Of the four out of ten that shopped, only 9% switched – 40% fewer than prior years. For example, in 2015, one fourth of MA members switched. Since then, switching numbers have consistently declined, and data indicates that this trend is going to continue, leaving less prospects on the table for MA marketers who need to meet acquisition benchmarks. This decline is not simply because seniors are resistant to invest the time in research. Less Medicare beneficiaries are switching because there are more four star plans on the market due to stability in CMS reimbursement. Plan design and premiums aren’t really changing and quality is generally equal across the board. Without any defining competitors, Medicare members have no compelling reason to switch.

MedSup Members Moving to MA:

Out of the small percentage of Age-Ins who are shopping and switching, the majority are still switching from MA to MA or MedSup to MedSup. However, the amount of seniors switching from MedSup to MA is doubling year over year, indicating that conducting AEP marketing to MedSup beneficiaries can be successful. This marketing should clearly communicate the benefits of an MA in comparison to MedSup, including lower co-pays and co-shares, and the simplicity of medical and pharmacy being combined. The amount of Original Medicare members switching to MA is also steadily increasing, with all of this data supporting the overall growth in MA enrollment that is being seen.

Decisions Being Made in Advance of AEP:

Deft Research shows that at the start of the 2018 AEP season, 80% of Medicare beneficiaries planned to stay put and 96% did just that. Those most prone to switching already have it in their minds that they want to before the start of AEP. This is evidenced by the fact that nine out of ten of those who said they were thinking of switching at the start of AEP did indeed switch. What this means is that the decision is not being made during AEP – it’s being made during the other ten months of the year. Medicare marketers need to extend their AEP marketing activity throughout the entire course of the year, going beyond the tried and true Happy Birthday cards and creating year-round cross-channel direct mail campaigns that bring prospects to personalized online decision support tools and high-value content. Identify the 15% who are undecided at the start of AEP and already in the mindset to switch, and you can win.

Target Age-In Demographics Changing:

Around the time of 2011, the recession was deeply impacting employment and many seniors were forced to take early retirement. Today, half as many seniors are taking Social Security at age 62. This is in part due to an improving economy and decreasing unemployment, but is also due in large part to the fact that today’s Boomer is living longer and doesn’t have adequate savings. Boomers would rather take Social Security later to get the maximum payout. Only 20% of those 12 months away from age 65 are shopping around because they are retiring later in life. In 2017, of 1,040 seniors surveyed, over 25% said that they do not expect to receive Social Security until age 66 and just over half plan to enroll in a Medicare plan at initial eligibility. This is significantly changing the age of the target Age-In and as a result, the Age-In marketing approaches payers are applying. Those age 66 are no longer late to Medicare – they are either soon to be new enrollees or have not yet made up their minds on when they are going to enroll, making them viable prospects that should be included in marketing.

Retaining Existing Base Essential:

With the number of switchers dramatically diminishing year over year, payers must focus on converting the members they already have – those that are theirs to win in the first place and the easiest to gain. The most effective way payers can convert their existing Commercial base into Medicare customers is by ensuring they are delivering a personalized, seamless customer experience year round. But even more essential is consistently sending out direct mail and digital communications that make Commercial members aware of the Medicare plans their existing carrier offers. Deft Research indicates that half of seniors polled were uncertain as to whether their Commercial/Group plan even offers Medicare. This odd reality exists as a result of deep fragmentation within payer organizations. Commercial marketing teams operate as completely separate entities from MA marketing, when they should be working in alignment. This deep silosm is resulting in members receiving communications that don’t leverage their existing member data and speak to them like strangers, as opposed to valued members. But how do you know if your existing members approaching Age-In are more prone to choose MA or MedSup? By looking at their data. People who choose MA do so because they want the simplicity of their medical and drug being combined and the lower co-pays for doctor visits. The primary reason people choose MedSup is for network flexibility – they can see any doctor or hospital they choose. Evaluating the number of out-of-network providers a member sees as well as their usage of medical and prescription benefits should tell you which plan to pitch.

Personalized Outreach Driving Conversion:

The most effective method for driving online conversion is personalized outreach from a broker (77%), particularly outreach that includes quick quotes, with this method driving 19% conversion. 62% is driven from a referral site, 46% via organic search, and 29% from a Web campaign. While leveraging a variety of digital marketing efforts is important, data clearly shows that the more personalized the digital broker/agent outreach, the more likely the individual is to shop. Personalized decision tools also help to drive online enrollment, including tools that allow the consumer to calculate the cost of doctor visits and prescriptions. 76% of seniors are willing to supply data and take the time to fill out lengthy forms if they know they are going to get a personalized recommendation in return and seniors are four times more likely to select the best-fit plan if a decision support tool is provided.

Online & Mobile Shopping Activity Growing:

53% of those age 60-64 have shopped online for health insurance and 37% are comfortable enrolling online with little assistance. While direct mail has long been the gold standard of AEP marketing and still stands strong, online activity is growing throughout AEP, and direct mail is now being used as a driver to personalized online experiences as opposed to a plan awareness piece. More consumers are coming in via mobile as well – 18.2% in AEP 2018 and 14.2% via tablet. Payers are not just getting more online traffic though – they’re getting better traffic. Bounce rates are decreasing and conversion rates on smartphones are increasing. From a behavioral perspective, there are several different kinds of online Medicare insurance shoppers payers should be aware of. According to Deft, 18% are the “resistors” – the consumers who don’t want to look at many options and invest much time into the process, who are difficult to reach in most channels and often resort to agents. 42% are the “browsers” – those that are willing to shop online, but only for a 30 minute time span and only if personalized, quick information is provided along the way. This segment is the most likely to enroll, and thus the segment payers should look to target by tracking and analyzing their website behavior via Google Analytics. Then, there are the “researchers” (18%) – those that spend one to four hours shopping online, returning back many times in order to get the right answer, and are the most digitally experienced shoppers . Last but not least is the most difficult group of all, the “maximizers” (22%), this group is committed to researching and evaluating as long as it takes, they are tied to specific doctors and Rx’s, and are often paralyzed by analysis.

Payers looking to capture the opportunity of growing MA enrollment should adopt more consumer-centric marketing models, including integrating online decision supports tools, digitally enabling brokers to push out personalized communications on-demand, and tearing down departmental silos to forge conversion marketing plans that leverage member data in highly creative, personalized ways. Show the member you know and understand them – and you can win their business for life. Need help translating these insights into real-world executions? Cierant can help. Overseeing the personalization, production, and distribution of AEP acquisition marketing for America’s leading health plans, we offer both the industry expertise and end-to-end services you need to optimize your cross-media marketing across all facets. Call 203-731-3540 or email inquiries@cierant.com to request information on our AEP acquisition marketing services.

]]>Investing in Medicare Advantage Market Growthhttp://www.cierant.com/investing-in-medicare-advantage-market-growth/ Wed, 20 Dec 2017 16:36:00 +0000http://www.cierant.com/?p=6387Medicare Advantage is marching towards 70% market penetration, according to global management firm L.E.K. Consulting. The consulting group based their forecast model on a number of factors, including the fact that several urban and rural counties have already achieved a penetration rate of 55%-65%, and most are increasing by at least one percentage point a year. For example, in Miami-Dade, Florida, of the 444,059 who are eligible for MA this year, 290,539 enrolled ( 65.4%) in MA, in comparison to only 55% in 2012 . That is a 2.1% average annual percentage point increase.

Drivers of Long-Term MA Penetration Growth

Beyond the fact that there is a high population of Boomers aging-in, there are several other key factors expected to drive this long-term growth. One of these factors is the high level of consumer satisfaction with MA plans among beneficiaries. Consumers value the predictability it brings to their medical expenses, the care coordination it offers, and the overall lower total annual healthcare costs it delivers in comparison to Original Medicare and Medicare Supplement plans. Payers also like MA plans because they make more money off them. According to L.E.K., Medicare Advantage plans yield higher nominal revenue and operating margin. For example, the average per-member per-month (PMPM) revenue is $800-$1,200 for an MA plan, with an operating margin of $30-$60. The PPPM revenue of a Medicare Supplement plan is $180-$22, with an operating margin of $10-$18. MA plans are a win-win scenario for all involved parties.

In addition to an increased desire for care coordination, rising premiums, and higher medical costs, another driver of MA growth is a new provision that was added to the Medicare Access and CHIP Reauthorization Act ((MACRA). This provision will be banning Medicare Supplement insurers from selling plans that cover the Part B deductible, effective for plan year 2020. Two of the most popular Medicare Supplement plans cover the Part B deductible – policies C and F. These plans allow beneficiaries to receive preventive care without having to meet a deductible or pay co-insurance. With Plans C and F no longer available, a spike in MA enrollment and a change in overall age-in health plan purchase behavior is expected.

Key Populations to Comprise the Growth

Much of the increased market penetration will come from Original Medicare, which could decrease more than 20 points, from 40% to 10%-20% penetration, according to L.E.K. This decrease in Original Medicare will be a result of rising healthcare cost, making the out-of-pocket responsibilities of co-insurance overly burdensome for seniors. According to the Kaiser Family Foundation, expenditures for physician and other professional services increased approximately 5.4% per year from 2000 to 2014, while expenditures on prescription drugs and other medical non-durables increased 6.2% per year.

New enrollees could also come from age-ins with chronic conditions that require the level of care management that only MA plans provide. According to the Centers for Disease Control and Prevention, the number of seniors with multiple chronic conditions increased by approximately 8% from 2000 to 2010. The United Health Foundation also found that the age-in population is 7% more likely to be obese and 6% more likely to have diabetes than those who turned 65 in 1999.

With Medicare Advantage enrollment expected to become the predominate product of seniors, payers who wish to take advantage of this trend and grow their market share should look into expanding into new counties, investing in targeted age-in marketing and sales strategies, maximizing the appeal of their product design, and investing in superior care management services.

To learn how you can claim your stake on this high-opportunity market with new age-in marketing approaches, please call 203-731-3555 or email inquiries@cierant.com. With a decade of experience overseeing the age-in marketing strategies of some of America’s largest MA plan providers, we not only offer years of hands-on experience, but the data modeling, personalized composition, and omnichannel execution services to support.

]]>Converting 2018 MMG Change into Savings Opportunityhttp://www.cierant.com/converting-2018-mmg-change-into-savings-opportunity/ Wed, 20 Dec 2017 16:35:12 +0000http://www.cierant.com/?p=6397September 30th has long passed, but now is the time to reflect on your ANOC/EOC fulfillment processes in order to implement new efficiencies for next year. As a full-service member communications management company, we take pride in keeping our clients informed of new regulatory change, especially when it can be converted into new savings. With that in mind, below are several key changes that were included in the 2018 Medicare Marketing Guidelines (MMG). If you were unable to fully address these changes this year due to the late release of the MMG, we highly advise evaluating how you can for next year.

New Formulary Flexibility

According to 60.4.3 of the MMG 2018, plans can now either:

a. Send enrollees a hard copy of the full or abridged formulary at the time of enrollment and annually, either attached to the EOC or mailed separately. b. Send a hard copy notice describing where enrollees can find the online formulary and how to request a hard copy. This notice must be a stand-alone document (i.e., not bound with other materials) and may be included in the same mailing envelope as the (ANOC/EOC).

If the plan will allow requests for a hard copy by email, then they must communicate the following:

“If you have a question about covered drugs, please call [customer service phone #] or visit [URL] to access our online formulary. If you would like a formulary mailed to you, you may call the number above, request one at the website link provided above, or email [Part D Sponsor email address].”

If the plan does not wish to allow for requests for hard copies via email, then they must communicate the following:

“If you have a question about covered drugs, please call [customer service phone #] or visit [URL] to access our online formulary. If you would like a formulary mailed to you, you may call the number above, request one at the website link provided above, or email [Part D Sponsor email address].”

With most plans already including a notice of how to access electronic versions of the provider directory/pharmacy directory in their ANOC/EOC’s, content about how to access one’s formulary and request hard copies can simply be added to the directory notice as a combined piece. Plans that were unable to integrate this notice or secure the print-on-demand capabilities needed to support the fulfillment of small-volume orders should ensure that they have solutions in place for next year in order to take advantage of the savings. In addition, directing members to an email address for the submission of hard copy requests may not be the most efficient method. We strongly advise integrating a form onto your website or on a standalone landing page/micro site connected to a production order management database.

Email as a Marketing Channel

According to 70.1 of the MMG 2018, “A Plan/Part D Sponsor may initiate separate electronic contact. Plans/Part D Sponsors must provide an opt-out process to no longer receive electronic communications.“

This new permission means that Medicare marketers can now email prospects, so long as there is an unsubscribe option and the proper disclaimers are included. This translates into not only more personalized and consistent outreach opportunity, but also more savings in being able to minimize direct mail volume. With email now a viable pre-sale marketing channel, Medicare Advantage marketers should be diligently working to build segmented prospect email lists while identifying an email software provider that can support both high-level personalization as well as high-level data security and engagement reporting.

Householding Now Allowed

For the first time, plans can send a single copy of enrollment materials (all materials noted in section 30.7) to a household of multiple members receiving the same plan coverage, with the obvious exception of member ID cards. According to section 30.7.1 of the MMG 2018, the following criteria must be met in order to permit householding:

The recipients are enrolled into the same plan (i.e., have the same contract and PBP number).

The recipients have the same address.

There is reasonable assurance that the individuals are related (e.g., they have the same last name) or have otherwise received consent from the recipients if they are.

MA plans should not take any shortcuts in documenting their criteria for “reasonable assurance” though. Plans that were unable to get the data together this year to support householding should consider identifying a new fulfillment partner for next year that offers comprehensive data list processing and householding services in order to reap the print savings next year.

15-Day Input of ANOC/EOC Mail Dates

ANOC/EOC material must be inputted with the actual mail dates into HPMS within 15 days of mailing the material. This means having real-time reporting in place for the mail distribution of ANOC/EOCs that is viewable at the individual member level and that can easily be exported into HPMS.

We make it easy for our clients to meet this mandate by offering an application that real-time reports on ANOC/EOC status at the point of file receipt, production, fulfillment, distribution and mail delivery—all searchable by member ID. If you’re current vendor does not offer granular-level mail distribution tracking, then perhaps it’s time to consider one who does or a reporting system that can integrate with your existing workflows.

The ability to migrate formularies to print-on-demand, e-market to MA prospects, and integrate householding offers tremendous savings and workflow efficiencies for the MA plans able to execute. If you’re struggling to achieve any of the following with your current vendors, please contact us and one of our consultants would be happy to outline custom implementation strategies for your programs.

Please call 203-731-3555 or email inquiries@cierant.com to explore how you can achieve a more cost-effective and compliant ANOC/EOC process next year.

]]>Three Factors to Maximizing Millennial Healthcare Marketinghttp://www.cierant.com/three-factors-to-maximizing-millennial-healthcare-marketing/ Tue, 28 Nov 2017 16:29:12 +0000http://www.cierant.com/?p=6277Open enrollment season is underway for most health plans and with millennials representing America’s largest living generation, the acquisition success of many payers will be based on how well they addressed the current healthcare state of millennials.

The Transamerica Center for Health Studies (TCHS), a nonprofit foundation dedicated to informing the national healthcare conversation through research and analysis, conducted a 2016 survey of 1,171 US millennial adults born between 1980 and 1997, titled “Young Adults’ Healthcare Reality.” The study looked to evaluate millennials’ experiences with health insurance and their plans for health and wellness in the future in an effort to guide the dialogue on healthcare policy and offer payers insight into opportunities for millennial outreach improvement.

The payers who will be successful in gaining new millennial business this season or next will have considered the following three factors that the TCHS report revealed:

1. Affordability is the most important characteristic of healthcare. When asked what characteristics of the healthcare system today are most important to them, the most common response by far was being able to afford the care they need (37%), making affordability the most important characteristic of healthcare for millennials. Seven in ten (70%) millennials say that cost is a very important factor when looking for healthcare and nearly half of millennials struggle to pay for their healthcare. In fact, most have taken some action to avoid or minimize healthcare costs in the past year, including skipping doctor visits and neglecting to refill prescriptions.

With one in five (21%) millennials unable to afford their routine healthcare expenses and 66% responding that any premium at or above $200/month is unaffordable, it’s not surprising that 16% reported that they do not plan on having insurance in 2017 due to lack of affordability. Despite those hesitant to enroll due to financial concerns, about one third of uninsured millennials do plan to get insured within the next year; therefore, there is great opportunity in engaging this segment, if done right.

When targeting millennials, whether it be the insured or the uninsured, payers need to make affordability their key value proposition and messaging focus, leveraging their direct and digital marketing efforts to create clear transparency around pricing and ensuring agents are trained to guide these consumers to the lowest-cost plan for their budget. Pricing transparency and the emphasis of available healthcare financial management support, whether it be consulting or expense planning tools, can be effective tactics for easing millennial cost concerns.

2. Lack of knowledge remains the biggest barrier to enrollment. While the number of uninsured millennials has declined to a low of 11%, of the uninsured, 37% (1 in 3) have never had health insurance and 52% have been uninsured for over two years. This is coupled by the fact that 57% of the uninsured only have a high school education or less. Payers participating in the Individual marketplace who want to capture the uninsured millennial market should adapt more aggressive outreach efforts that are tailored to this group’s level of health literacy and need for healthcare advocate support services. This need for more informative outreach is evidenced by the fact that half (55%) of the uninsured say that they are not at all or not very informed about the health insurance options available to them. Many (four out of five) did not enroll in Individual coverage before the ACA deadline because they did not know how to apply or did not feel informed enough about the ACA and their options. While affordability may be the key decision maker in healthcare plan selection, unawareness of enrollment dates and coverage options can derail enrollment altogether.

This lack of knowledge isn’t just limited to the uninsured though. Over a third (35%) of insured millennials say they are not at all or not very informed about the health insurance options available to them. This indicates that payers are failing to reach out to millennials with pre-enrollment marketing that explains and compares their plan options and how to enroll in an easily understandable, low healthcare literacy way. Millennial healthcare education and enhancement of pre-enrollment marketing has to be a priority in order to capture the millennial market.

3. More than half report having some health condition. Depression, anxiety and obesity run high among millennials, with 23% reporting that they have been diagnosed with either depression, anxiety, ADD/ADHD, or alcohol/drug treatment. Another 54% has been diagnosed with a chronic illness. As a result, 29% want more affordable mental health/counseling services and 36% more affordable wellness visits. Payers looking to reach millennials should highlight the managed care and specialty services their plan offers, such as in-network mental health services, addiction programs and wellness service offerings.

Millennials need to know that the value of a plan will extend far beyond emergency scenarios— they need to know that a plan offers a comprehensive array of ongoing services to support their holistic well-being. The payers who can speak to millennials on a one-to-one level about how the unique wellness services and digital tools they offer to enhance their overall well-being will be the ones to win their hearts and business.

While the millennial generation may not always make shopping for healthcare a priority in their hectic lives, the payers that can cut through the noise and communicate with them on a simplistic level about the value of their plan in the relation to the benefits they care about most can help them realize the importance of investing in quality healthcare.

Tear down millennial stereotypes that healthcare is only for when your sick and demonstrate how your plan is committed to achieving their health and wellness goals with a fresh marketing approach. Need help developing or executing the right strategies? Whether you’re looking to optimize your direct mail, mobile, email or Web marketing efforts, Cierant can help. Currently managing millions of personalized, cross-media integrated annual enrollment campaigns across our portfolio of insurance clients, we are experts in the seamless composition and production of high-impact pre-sale marketing. Call us at 203-731-3555 to learn about our services or email 203-731-3555 to request a demo of our work in action.

]]>Channeling CX Dissatisfaction into Opportunityhttp://www.cierant.com/channeling-cx-dissatisfaction-into-opportunity/ Tue, 28 Nov 2017 16:26:42 +0000http://www.cierant.com/?p=6270Consumers aren’t just selecting their healthcare policies anymore – they’re shopping for them. Studies show that close to 20% of policies sold during open enrollment will be shopped by consumers via private and public exchanges. In the next few years, that number is expected to rise to 50% or higher as more employers move to private exchanges. The key to winning in this hyper-competitive environment is an exceptional customer experience, but today, many payers aren’t delivering one.

Convergys, a world leader in customer experience outsourcing, released the findings of their 2016 CX Metrics & Omnichannel Trends Research, a report based on a survey of 6,400+ consumers taken in June of 2016. The research found that the healthcare insurance provider industry ranks third to last in customer experience, just above cable, satellite, and wireless providers. While this widespread dissatisfaction may sound disheartening, many payers are channeling this reality into new opportunity by focusing on improving the following three centerpieces of the payer customer experience:

1. The Shopping Experience Every initial interaction with a payer, from placing a call to customer service to engaging in a conversation with a chat bot or clicking an email call-to -action, offers data collection opportunity. The payers that are able to collect and leverage as much customer intelligence as possible in the initial shopping phases can then craft pre-sale communications that feature plans and emphasize benefits that appeal to the unique needs of the customer. With advances in personalized composition software making tailored communications easier than ever before, payers can create templated direct mailers and plan decision guides that allow for dynamic insertion of plan benefits and key messaging based on consumer intelligence data. Website analytics during open enrollment also offer great insights. For example, a page with high traffic or long average session times might be an indicator of high-value content – content that may be serving to educate the consumer on a confusion point that should be integrated into agent training programs.

2. The Claims Experience While some payers believe that their single greatest competitive strength is their ability to process a medical claim quickly and correctly and at a low cost to the consumer, most consumers consider this a baseline expectation of conducting business with a payer. Convergs’ CX Metrics & Omnichannel Trends Research found that the cost of committing even the slightest error in claims processing is high, and can be a deal breaker for winning the consumer’s continued business next year. For one client, Convergs found that outdated claims processing guidelines drove 280,000 unnecessary calls into customer care, skyrocketing costs and putting future business from every one of these customers at risk. Healthcare leaders must make optimization of claims processing a priority, beginning by mapping the consumer journey and identifying all the pain points against internal processing system to get to the root cause.

2. The Channel Experience Many payers make broad generalizations of channel preference without taking the time to evaluate what customers actually prefer based on on analysis of behavioral data. For example, one payer optimized their website for self-service bill payment under the assumption that was the preferred payment channel, only to find that many customers prefer automated phone payments, and that there were errors in their IVR system, such as poor menu structure and missing authentication. Payers must take the time to look at current channel usage rate for different activities and let their channel optimization strategy be guided by what consumer behavior tells them. Channel preference often varies from person to person though, as some consumers prefer digital self-service tools for conducting administrative tasks (44%), and others (27%) prefer speaking directly to an agent or call center. For this reason, it is crucial payers are able to understand individual channel preference and let their member interactions be driven by this intelligence.

“Brands need to recognize that they are serving a multigenerational population – in fact, in America alone, there are six distinct generations living today,” said Kathy Juve, ‎Chief Marketing Officer of Convergys. “Our CX research shows planning a strategy based on generational assumptions alone will not lead to success for retailers in today’s competitive environment. From grandparents to preteens, all consumers enjoy using technology and expect technology-enabled solutions when they seek customer service support.”

As expressed by Convergys’ CMO, the most significant takeaway from their research findings is that the continued growth of omnichannel optimization is essential to avoiding customer frustration as a technology-enabled customer experience is important to all generations. In order to support omnichannel optimization initiatives, consumer engagement efforts must move beyond printed direct mail communications and static patient portals to tailored engagement solutions driven by a centralized content repository and a real-time customer intelligence database. To learn how Cierant’s CommONE: Connect suite of personalizedengagement solutions makes omnichannel optimization simple, visit www.cierant.com/explore/hcs/commone-connect/ or email inquiries@cierant.com to request a demo.